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首页> 外文期刊>Seminars in thoracic and cardiovascular surgery. Pediatric cardiac surgery annual >Principles of Antegrade Cerebral Perfusion During Arch Reconstruction in Newborns/lnfants
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Principles of Antegrade Cerebral Perfusion During Arch Reconstruction in Newborns/lnfants

机译：新生儿/婴儿足弓重建过程中整体脑灌注的原理

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Antegrade cerebral perfusion (ACP) is a cardiopulmonary bypass technique that uses special cannulation procedures to perfuse only the brain during neonatal and infant aortic arch reconstruction. It is used in lieu of deep hypothermic circulatory arrest (DHCA), and thus has the theoretical advantage of protecting the brain from hypoxic ischemic injury. Despite this, recent comparative studies have shown no difference in neurodevelopmental outcomes with ACP versus DHCA for neonatal arch repair. This article presents animal and human data demonstrating that ACP flows less than 30 mL/kg/min are inadequate for many patients, and may be the explanation for lack of outcome difference versus DHCA. A technique for ACP, its physiologic basis, and a neuromonitoring strategy are presented, and then the results of an outcome study are reviewed, showing that with ACP technique at higher flows of 50 to 80 mL/kg/min guided by neuromonitoring, periventricular leukoma-lacia is eliminated on postoperative brain magnetic resonance imaging after neonatal cardiac surgery.
机译：整合式脑灌注（ACP）是一种心肺旁路技术，在新生儿和婴儿主动脉弓重建过程中，使用特殊的插管程序仅灌注大脑。它被用来代替深部的低温循环骤停（DHCA），因此具有保护大脑免受缺氧缺血性损伤的理论优势。尽管如此，最近的比较研究表明，对于新生儿足弓修复，ACP与DHCA的神经发育结果无差异。本文提供的动物和人类数据表明，ACP流量低于30 mL / kg / min对于许多患者而言是不够的，并且可能是与DHCA缺乏预后差异的原因。介绍了一种用于ACP的技术，其生理基础和一种神经监测策略，然后回顾了一项结果研究的结果，结果表明，在神经监测，脑室周围白细胞瘤的指导下，以50到80 mL / kg / min的更高流量使用ACP技术新生儿心脏手术后术后脑磁共振成像消除了-lacia。

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